P2576 - Primary Sclerosing Cholangitis: Evaluating Colorectal Cancer Risk With and Without Concurrent Inflammatory Bowel Disease

Tarek Odah, MD¹, Abdelrahman Yakout, MD¹, Aasma Shaukat, MD, MPH², Fadi F. Francis, MD³, Nayantara Coelho-Prabhu, MD, FACG⁴, Rami Tfayli, MD¹, Francis A. Farraye, MD, MSc¹, Jana G. Hashash, MD, MSc^1
1Mayo Clinic, Jacksonville, FL; ²NYU Langone Health, New York, NY; ³University of Pittsburgh, Pittsburgh, PA; ⁴Mayo Clinic, Rochester, MN

Introduction: Primary sclerosing cholangitis (PSC) is a chronic and progressive liver disease characterized by bile duct inflammation and subsequent cholestasis. Almost 80% of patients with PSC have inflammatory bowel disease (IBD), particularly ulcerative colitis (UC). Patients with both PSC and IBD are at an increased risk for colorectal cancer (CRC). Limited data exist regarding CRC risk among patients with PSC alone. Our study aims to compare the association of PSC with CRC in patients with and without concurrent IBD.

Methods: This is a multicenter retrospective study that included adult patients across our healthcare system with PSC who underwent a colonoscopy between January 2000 and May 2024. Data on patient demographics, family history, medical history including IBD and CRC history, and endoscopy findings were recorded. Statistical analysis included logistic regression and Fisher's exact test.

Results: A total of 400 patients met the inclusion criteria and were categorized into three cohorts: 74 in the PSC-only group, 74 in the PSC/IBD group (PSC preceding IBD or both diagnoses within three months), and 252 in the IBD-first group, diagnosed with IBD before PSC. The average follow-up time from PSC diagnosis was 78.8 months ± 81.2. Table 1 presents the demographics, medical, and endoscopic characteristics of the cohorts. In the PSC-only cohort, no patients developed CRC, while the PSC/IBD cohort had 2 cases (3.3 per 1000 person-years) and the IBD-first cohort had 12 cases (7.7 per 1000 person-years). In patients with both IBD and PSC, there was no significant statistical difference in the association of CRC between the IBD-first PSC cohort and the PSC/IBD cohort (OR 1.8, CI 0.4-8.2; p=0.45). When comparing the PSC-only cohort to the PSC/IBD cohort, dysplasia was found in 4.1% and 9.5% (p=0.33), adenoma was found at 12.2% and 17.6% (p=0.49), while sessile serrated lesion was found at 5.4% and 8.1% (p=0.75), respectively.

Discussion: In conclusion, our study revealed no cases of CRC in the PSC-only cohort, while there were 2 cases (3.3 per 1000 person-years) in the PSC/IBD cohort, and 12 cases (7.7 per 1000 person-years) in the IBD-first PSC cohort. The presence of dysplasia, adenoma, and sessile serrated lesions in all groups, including the PSC-only cohort, highlights the importance of robust surveillance and management strategies. Larger studies are required to establish optimal colonoscopy frequency in the PSC-only population.


Disclosures:


Tarek Odah, MD¹, Abdelrahman Yakout, MD¹, Aasma Shaukat, MD, MPH², Fadi F. Francis, MD³, Nayantara Coelho-Prabhu, MD, FACG⁴, Rami Tfayli, MD¹, Francis A. Farraye, MD, MSc¹, Jana G. Hashash, MD, MSc¹. P2576 - Primary Sclerosing Cholangitis: Evaluating Colorectal Cancer Risk With and Without Concurrent Inflammatory Bowel Disease, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.